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Evaluation of pre-, peri- and post-natal care delivery systems

Objective

The Concerted Action included four subprojects, focused on:

- Assessment of repeated vaginal examination during pregnancy, and effectiveness in the prevention of preterm delivery.
- Evaluation of different policies of management of labour for primiparous women. This subproject included two trials, one on early amniotomy and use of oxytocin, the other on continuous support of the women during labour.
- Assessment of neonatal interventions to reduce mortality, disability and use of health services in very preterm infants. This subproject focused on the prevention of peri/intra-ventricular haemorrhage and assessed two treatments: ethamsylate, and plasma volume expanders.
- Implications for the health service of parental involvement in the care of very low birthweight infants in neonatal intensive care units.
The Concerted Action on evalution of prenatal, perinatal and postnatal care delivery systems has carried out 4 projects:

Effectiveness of repeated vaginal examination in pregnancy:
Results indicated that while repeated vaginal examinations do improve the prediction of preterm delivery the procedure was associated with an excess of prenatal hospital admissions.

An evaluation of different policies for managing labour of primiparous women:
One trial assessed the value of early amniotomy plus oxytoxin. This did not affect the rate of operative deliveries but might increase the risk of postpartum haemorrhage. Continuous support during labour, on the other hand, did reduce the rate of operative deliveries without affecting the health of neonates or mothers.

Assessment of neonatal interventions, in very preterm infants:
Two randomised controlled trials focused on prevention of peri/intraventricular haemorrhage (ethamsylate and plasma volume expanders) and of respiratory distress (surfactant). The ethamsylate trial so far provides no evidence of a difference in short term outcomes.

Implications for the health service of parental involvement in the care of very low birthweight infants in neonatal intensive care units:
The participating units differed greatly in their policies towards parental involvement and in facilities available. Parental behaviour also differed. Generally speaking, parents reported a high degree of satisfaction with the care of their infant but complained of insufficient communication with doctors and nurses.

Funding Scheme

CON - Coordination of research actions

Coordinator

Institut National de la Santé et de la Recherche Médicale (INSERM)
Address
16 Avenue Paul Vaillant Couturier
94807 Villejuif
France